Quetiapine in prolonged ICU delirium

Abstract

Introduction: Delirium affects up to 33% of acutely hospitalized patients. In ICU patients it can prolong the length of stay and increase mortality [1]. The optimal management of delirium requires a calm environment, sleep hygiene and correction of underlying factors (for example, infection). This can be a challenge in the ICU, and drug therapy, commonly haloperidol, clonidine, benzodiazepines or propofol, is often used [1]. Quetiapine, an atypical antipsychotic, has been used in acute delirium outside the ICU [2]. It has few extrapyramidal side effects, a short half-life and is mildly sedating. Our impression was that it had potential in the treatment of delirium. Methods: In a 30-bed tertiary ICU with more than 1,200 admissions annually we reviewed the notes of patients admitted from February 2008 to November 2009 who had a delirium treated with quetiapine. Patients were excluded if they were taking quetiapine prior to admission. The following data were recorded: Richmond Agitation and Sedation Score{Table presented} (RASS), duration of delirium, agents used, patient demographics and adverse events. Results: Five patients met the inclusion criteria (Table 1). All were males, aged 37 to 85 years. All had a prolonged delirium prior to the commencement of quetiapine and all were on a combination of four drugs (clonidine, haloperidol, lorazepam and propofol) that were not controlling their delirium. At 3 to 7 days following commencement of quetiapine the RASS scores were 0 and other drugs were ceased. No adverse effects were noted. Conclusions: Quetiapine was successful in controlling prolonged ICU delirium and allowed weaning of other medications in these patients. It may be a useful delirium therapy. Further studies are required to demonstrate efficacy and safety.